腕踝针联合耳穴贴压治疗卒中后肩手综合征的疗效观察

Observation on the efficacy of wrist-ankle acupuncture plus auricular point sticking for post-stroke shoulder hand syndrome

目的 观察在常规治疗和常规针刺治疗基础上腕踝针联合耳穴贴压治疗卒中后肩手综合征的近期和远期疗效以及安全性。方法 将160例卒中后肩手综合征患者随机分为对照组、耳穴组、腕踝针组和联合组,每组40例。对照组予西医基础治疗、常规康复治疗和常规针刺治疗,耳穴组在对照组基础上加用耳穴贴压治疗,腕踝针组在对照组基础上加用腕踝针治疗,联合组在对照组基础上联合腕踝针和耳穴贴压治疗。观察治疗前后4组疼痛视觉模拟量表(visual analog scale,VAS)评分、Fugl-Meyer运动功能评分法(Fugl-Meyer assessment,FMA)上肢运动评分和肩关节活动度的变化,比较4组临床疗效和不良反应发生情况。治疗后2个月进行随访,观察4组Barthel指数(Barthel index,BI)分级的情况。结果 4组总有效率比较,差异具有统计学意义(P<0.05);且联合组总有效率高于其余3组,差异具有统计学意义(P<0.05)。治疗后,4组VAS评分、FMA上肢运动评分和肩关节活动度均较治疗前改善(P<0.05);联合组上述各项指标均优于其余3组(P<0.05)。治疗过程中4组均未发生严重不良反应事件。随访时,4组BI分级比较,差异无统计学意义(P>0.05)。结论 在常规治疗和常规针刺治疗基础上,腕踝针联合耳穴贴压治疗卒中后肩手综合征可缓解肩痛,改善肩关节活动度和上肢运动功能,提高临床疗效。

Objective To observe the short-term and long-term efficacies and safety of wrist-ankle acupuncture plus auricular point sticking based on the conventional treatment and conventional acupuncture for post-stroke shoulder hand syndrome.Method One hundred and sixty patients with post-stroke shoulder hand syndrome were randomized a control group,an auricular point group,a wrist-ankle acupuncture group and a combination group,with 40 cases in each group.The control group received basic Western medical treatment,conventional rehabilitation therapy and conventional acupuncture.In addition to treatments given to the control group,the auricular point group received auricular point sticking therapy;the wrist-ankle acupuncture group received wrist-ankle acupuncture treatment;the combination group received wrist-ankle acupuncture plus auricular point sticking therapy.The visual analogue scale(VAS) score and the Fugl-Meyer assessment(FMA) upper extremity motor function score and shoulder movement were observed in the four groups before and after treatment.The clinical therapeutic effects and the occurrences of adverse reactions were compared between the four groups.The Barthel index(BI) rating was observed at the two-month follow-up after treatment.Result The total efficacy rate had a statistically significant difference among the four groups(P<0.05) and was higher in the combination group than in the other three groups(P<0.05).After treatment,the VAS score and the FMA upper extremity motor function score and shoulder movement improved in the four groups compared with before(P<0.05) and were better in the combination group than in the other three groups(P<0.05).No serious adverse reactions occurred in the four groups during treatment.The BI rating had no statistically significant difference among the four groups at the follow-up(P>0.05).Conclusion On the basis of the conventional treatment and conventional acupuncture,wrist-ankle acupuncture plus auricular point sticking can relieve shoulder pain,improve shoulder joint activity and upper limb motor function and heighten the clinical therapeutic effect in patients with post-stroke shoulder hand syndrome.